Stabilizing microfracture device

ABSTRACT

A microfracture device comprising a guide shaft having a proximal end and a distal end and defining an internal passage between the proximal and distal ends, the distal end having a curved tip, a stabilizing portion disposed along an outer surface of the guide shaft, at least a portion of the stabilizing portion being wider than the guide shaft, and a flexible element movably positioned within the internal passage of the guide shaft, the flexible element having a distal tip configured for driving into bone.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to and the full benefit of UnitedStates Provisional Application Ser. No. 61/436,653, filed Jan. 27, 2011,and titled “Stabilizing Manual Hip Microfracture,” the entire contentsof which is incorporated herein by reference.

FIELD

This document relates to a device for performing a microfractureprocedure.

BACKGROUND

Articulating body joints are surfaced with hyaline cartilage, which is avery durable low coefficient of friction natural material. Thesesurfaces are often damaged when subjected to high repeated loading, suchas when one runs. This is particularly true for lower body compressivejoints such as the ankle, knee, hip and spine.

Resurfacing of the cartilage surfaces is a large area of study in theorthopaedic industry. One technique used for resurfacing of thecartilage is referred to as microfracture. Rather than replacing thedamaged articular cartilage with an artificial implant, microfracturestimulates the body to replace the surface with a fibrous cartilage.Fibrocartilage is not as robust and does not have the low coefficient offriction that hyaline cartilage does, but it does provide patients withreduced pain and enables them to participate in an active lifestyle.

Microfracture procedures are generally performed by first removing thedamaged layer of cartilage. The damaged layer can vary from about 1 toabout 6 mm in thickness. A sharp microfracture pick is then driven about2 to about 5 mm through the underlying subchondral bone to a bloodsupply. When the pick is removed, a small channel remains. A series ofchannels can be formed in the subchondral bone such that blood travelsalong the channel and clots in the area of the removed cartilage.

SUMMARY

In a general aspect, a microfracture device includes a guide shafthaving a proximal end and a distal end and defining an internal passagebetween the proximal and distal ends, the distal end having a curvedtip, a stabilizing portion disposed along an outer surface of the guideshaft, at least a portion of the stabilizing portion being wider thanthe guide shaft, and a flexible element movably positioned within theinternal passage of the guide shaft, the flexible element having adistal tip configured for driving into bone.

Implementations may include one or more of the following features. Thedevice further includes a handle operatively coupled to the proximal endof the guide shaft. The handle defines a passageway configured toreceive a portion of the flexible element therethrough. The handle isoperatively coupled to the proximal end of the guide shaft such that theguide shaft can be translated proximally and distally relative to thestabilizing portion and rotated relative to the stabilizing portion. Theguide shaft includes at least one angled tip at the distal end of theguide shaft. The stabilizing portion includes a body defining aninternal passage that receives a portion of the guide shafttherethrough. A portion of the body includes a substantially flat outersurface. A portion of the body comprises a substantially curved outersurface. The body defines a longitudinally extending slit that permitsthe guide shaft to be disposed in and removed from the internal passageof the body. The stabilizing portion includes a flexible body having atleast one substantially curved outer surface. The flexible elementincludes a proximal end that is operatively configured to permittranslation of the flexible element proximally and distally through theinternal passage of the guide shaft. The proximal end of the flexibleelement is further operatively configured to permit rotation of theflexible element within the internal passage of the guide shaft. Theflexible element includes a flexible wire. The stabilizing portionincludes a recessed portion for receiving a portion of the curved tip ofthe distal end of the guide shaft.

In another general aspect, a surgical device includes a guide shafthaving a proximal end and a distal end, the guide shaft defining aninternal passage between the proximal and distal ends and having anangled tip at the distal end of the guide shaft, a support portiondisposed about an outer surface of the guide shaft, at least a portionof the support portion being wider than the guide shaft, a handleoperatively coupled to the proximal end of the guide shaft, the handledefining an internal passage, and a flexible element having a proximaland a distal end, the flexible element movably positioned within theinternal passage of the guide shaft and the internal passage of thehandle, the flexible element having an angled distal tip at the distalend of the flexible element.

Implementations may include one or more of the following features. Thesupport portion includes a body defining an internal passage thatreceives a portion of the guide shaft therethrough. A portion of thebody includes a substantially flat outer surface. The stabilizingportion includes a flexible body having at least one substantiallycurved outer surface.

In another general aspect, a method of performing a microfractureprocedure includes positioning a surgical device having a guide shaftwith a proximal end and a distal end and an angled tip at the distal endand a stabilizing portion disposed along an outer surface of the guideshaft proximate to a first bone surface such that an outer surface ofthe stabilizing portion is positioned against a portion of the firstbone surface, locating the angled tip of the guide shaft at a desiredpoint of stimulation, driving an angled tip of a flexible elementthrough the guide shaft and into a second bone surface, and removing theflexible element.

Implementations may include one or more of the following features. Themethod further includes engaging the angled tip of the guide shaft intothe second bone surface. The flexible element includes a flexible wire,and wherein driving the angled tip of the flexible wire comprisesstriking a proximal end of the flexible wire to translate the flexiblewire relative to the guide shaft. The flexible element includes aflexible wire, and wherein driving the angled tip of the flexible wirecomprising rotating a proximal end of the flexible wire to rotate theflexible wire relative to the guide shaft. The first bone surfaceincludes a portion of a femoral head and the second bone surfaceincludes a portion of the acetabulum. The stabilizing portion includesan outer surface having one of a substantially flat portion or asubstantially curved portion and the positioning step includespositioning one of the substantially flat or curved portions against theportion of the femoral head. The positioning step includes the step ofinserting at least a portion of the surgical device into an arthroscopiccannula.

The details of one or more implementations are set forth in theaccompanying drawings and the description below. Other features,aspects, and advantages will become apparent from the description, thedrawings, and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a side view of a microfracture device.

FIG. 1B is a partial perspective view of the microfracture device ofFIG. 1A.

FIGS. 2A-2B illustrate positioning and use of the microfracture devicewithin an acetabular region for performing a microfracture procedure.

FIG. 3A is a side view of an alternative implementation of amicrofracture device.

FIG. 3B is a partial perspective view of the microfracture device ofFIG. 3A.

FIG. 4 illustrates positioning and use of the microfracture device ofFIGS. 3A and 3B within the acetabular region for performing amicrofracture procedure.

FIG. 5 is a partial perspective view of the microfracture device of FIG.1A in a retracted position.

FIG. 6 is a perspective view of an angled distal tip for use in amicrofracture device.

FIGS. 7A and 7B illustrate alternative positioning and use of themicrofracture device of FIG 1A within an acetabular region.

FIG. 8 illustrates a side view of an alternative implementation of amicrofracture device.

FIG. 9 illustrates a method of microfracture stimulation of the presentdisclosure.

DETAILED DESCRIPTION

This document describes examples of microfracture devices that can beused during a microfracture procedure to create channels or holes insubchondral bone, for example, to stimulate the production offibrocartilage between an acetabular cup and a femoral head.

Referring to FIG. 1A, a microfracture device 100 includes a guide shaft102, a stabilizing portion 104, and a flexible element 106, which can beused to create holes or channels in, for example, subchondral bonetissue. The guide shaft 102 has a proximal end 108 and a distal end 110,and can be cannulated such that a lumen or internal passage (not shown)is disposed axially along its length. The flexible element 106, forexample, a flexible wire, can be positioned within the internal passagesuch that proximal and distal ends of the flexible element 106 extend,respectively, beyond the proximal and distal ends 108, 110 of the guideshaft 102. The flexible element 106 can be made from stainless steel,Nitinol, and/or other materials suitable for creating microfracturechannels in subchondral bone. The flexible element 106 can include awidened or thickened portion 106 a that helps to limit the flexibleelement 106 from buckling when compressed. At least a part of the outersurface of the stabilizing portion 104 is configured or adapted tocontact a portion of a bone surface, such as a contoured surface of thefemoral head (not shown), and can help stabilize the microfracturedevice 100 during microfracture surgery as described further below.

Referring also to FIG. 1B, the guide shaft 102 of the microfracturedevice 100 can be a generally cylindrical structure having a one-piececonstruction, or the guide shaft 102 can be made of multiple componentsthat are attached to each other via, for example, welding or a press fitengagement. The guide shaft 102 can be made from any biocompatiblematerial including polymers, metals, ceramics, or combinations thereof.The distal end 110 of the guide shaft 102 includes a curved tip region112 that can guide the flexible element 106 to a selected position andorientation with respect to a microfracture surgery site. For example,referring to FIGS. 1A and 1B, a sharpened distal tip 114 of the flexibleelement 106, which exits the guide shaft 102 through an opening (notshown) in a distal tip 116 of the guide shaft 102, can form an angle αwith respect to a shaft axis 118 such that a transverse channel can beformed into the subchondral bone of, for example, the acetabular cup.The angle α can be between about 20 degrees to about 90 degrees. In somecases, the angle α can be greater than 90 degrees such that the tip 114of the flexible element 106 points towards the proximal end 108 of theguide shaft 102. The curved tip region 112 can be an integral portion ofthe guide shaft 102 or can be separately attached to the guide shaft102. In some cases, the curvature of the curved tip region 112 can beadjusted by the surgeon such that the angle α can be changed as requiredby the particular microfracture procedure.

Referring to FIG. 1B, the stabilizing portion 104 includes a body 120. Aportion of the body 120 can receive the guide shaft 102. For example, aninternal passage (not shown) through the body 120 can receive at least aportion of the guide shaft 102. In some cases, the stabilizing portion104 can be slipped over the guide shaft 102 and adjustably positioned ata particular location along the guide shaft 102. Additionally, the body120 can define a slit 122 along the stabilizing portion 104 such thatthe guide shaft 102 can be disposed in and removed from the internalpassage (not shown) through the slit 122. In some implementations, thestabilizing portion 104 can be insert-molded around the guide shaft 102.In other implementations, the stabilizing portion 104 can be integrallyformed as part of the guide shaft 102. For example, the guide shaft 102and the stabilizing portion 104 can be formed together in a singlemachining or molding step. Alternatively, or additionally, variousattachment procedures, such as welding or the use of adhesives, may beused to attach the stabilizing portion 104 to the guide shaft 102.

The body 120 of the stabilizing portion 104 includes a wide portion 124having a generally trapezoidal shape as best seen in FIG. 1B. The wideportion 124 can include other geometries, such as a semicircle or arectangle, and can extend laterally beyond one or both sides of the body120. Additionally, the wide portion 124, which can be integrally formedwith or separately attached to the body 120, includes an outer surface126 for contacting a bone surface, such as a surface of a femoral head(FIG. 2A) and/or a hip capsule 700 as shown with reference to FIGS. 7Aand 7B. The outer surface 126 generally has a width W_(s) that isgreater than a width W_(g) or diameter of the guide shaft 102. In somecases, the width W_(s) can be approximately twice as large as the widthW_(g). The increased width W_(s) of the outer surface 126 can helpdistribute forces applied to the contacting bone or soft tissue surfaceover a larger area, thereby reducing possible damage to the bone surfaceor, for example, the cartilage overlying the bone surface. All orportions of the outer surface 126 can be substantially flat. In somecases, all or portions of the outer surface 126 can be substantiallycurved, contoured, or shaped. For example, all or portions of the outersurface 126 can be curved to match or substantially match or conform toa corresponding curvature of a portion of the femoral head as discussedfurther below. Also, as discussed below, the stabilizing portion 104 canhave a leading edge 128, a trailing edge 130, and a recessed portion 132for improved insertion into and removal from, respectively, a surgicalsite through, for example, an arthroscopic cannula. The stabilizingportion 104 can be made from any biocompatible material includingpolymers, elastomers, metals, ceramics, or combinations thereof.Additionally, or alternatively, the stabilizing portion 104 can be madefrom autoclavable materials such that the stabilizing portion 104 may bereused after surgery. In some cases, the outer surface 126 can include adifferent surface treatment, surface texture, and/or surface material tominimize slipping while in contact with the bone surface. Alternatively,stabilizing portion 104 can incorporate a soft surface 126 made from anelastomer or balloon to conform to the corresponding curvature of aportion of the femoral head or hip capsule.

Referring again to FIG. 1A, the microfracture device 100 includes ahandle 134 that can be coupled to, or formed integral with, the guideshaft 102 near the proximal end 108 to control the movement of the guideshaft 102. Additionally, the stabilizing portion 104 can include ahandle portion 136 located at a proximal end of the stabilizing portion.For example, the handle portion 136 can be hook-like structure or otherfinger-engageable structure that is coupled to a proximal region of thebody 120 of the stabilizing portion 104. In use, the user can move, bothtranslationally and rotationally, the handle 134 relative to the handleportion 136, or vice versa, such that the guide shaft 102 movescorrespondingly or differently with respect to the stabilizing portion104. Thus, by manipulating the handle 134 and/or the handle 136, a usercan vary the position of the distal tip 114 of the flexible element 106as well as the distal tip 116 of the guide shaft 102 relative to, forexample, the stabilizing portion 104.

Referring now to FIGS. 2A and 2B, during a microfracture procedure, auser, such as a surgeon inserts the microfracture device 100, forexample, through an arthroscopic cannula through a skin of a patient,and positions the device 100 near a microfracture site 202. Themicrofracture site 202 can be a region where there is breakage in acartilage layer (not shown) or where a portion of the cartilage layerhas been removed and where microfracture may stimulate the growth offibrocartilage. As shown in FIG. 2A, an exemplary microfracture site 202is at a desired location on the acetabular cup 204, between theacetabular cup 204 and the femoral head 206. In use, the surgeon canfirst position the wide portion 124 of the stabilizing portion 104 suchthat the outer surface 126 of the wide portion 124 contacts an outersurface of the femoral head 206 (FIG. 2A) and/or hip capsule 700 (FIGS.7A and 7B). Following positioning of the wide portion 124, the surgeoncan position the guide shaft 102, for example by manipulating the handle134, such that the distal tip 116 of the guide shaft 102 contacts anouter surface of the acetabular cup 204 at the microfracture site 202.In some cases, the distal tip 116 of the guide shaft 102 can bepartially driven into the bone surface by levering handle 134 aroundsurface 126 of stabilizing portion 104. One or more angled teeth 606located at the distal end of the guide shaft 102 as described in moredetail below with respect to FIG. 6 may augment the ability to driveguide shaft 102 into bone and thus increase the stability ofmicrofracture device 100.

After placing the microfracture device 100 in the selected positionrelative to the microfracture site 202, the distal tip 114 of theflexible element 106 can be driven through the guide shaft 102 and intothe microfracture site 202 to create one or more channels in thesubchondral bone. The flexible element 106 may also rotate within theinternal passage of the guide shaft 102 and be driven into thesubchondral bone with translational and/or rotational movement to createthe microfracture channels. For example, a distal tip of the flexibleelement 106 can be driven into bone by rotating a proximal end of theflexible element 106. The proximal end of the flexible element 106 canexit the guide shaft 102 through an opening (not shown) at the proximalend 108 of the guide shaft 102 and through an opening 208 (FIG. 2B) at aproximal end of the handle 134. A manual rotation device can be attachedto the proximal end of the flexible element 106.

In some implementations, the flexible element 106 may be a flexible wirethat can translate linearly, i.e. proximally and distally, through theinternal passage of the guide shaft 102 to create the microfracturechannels. For example, a distal tip of the flexible wire can be driveninto bone by striking a proximal end of the flexible wire. The curvedshape of the guide shaft 102 helps translate an impact force orientedaxially relative to the wire at the proximal end of the wire to adriving force oriented axially relative to the wire at the distal end ofthe wire. In other words, an impact force at the proximal end of theflexible wire that is oriented in a direction generally parallel to thesurface of the microfracture site 202 is transferred to a driving forceat the distal end of the flexible wire that is oriented in a directiongenerally transverse to the surface of the microfracture site 202. Theresulting axial impact force at the distal end of the wire allows thedistal tip of the flexible wire to be driven into the bone.

During the microfracture procedure steps outlined above, the wideportion 124 of the stabilizing portion 104 can help stabilize and/orminimize unwanted movement of the guide shaft 102 relative to themicrofracture site 202. For example, normal and/or friction forcesgenerated between the femoral head 206 and/or hip capsule 700 (FIGS. 7A,7B) and the outer surface 126 may counteract some of the reaction forcesgenerated at the microfracture site 202 as a result of the rotational ortranslational drilling process discussed above. Further, the increasedsurface area of the outer surface 126 can help distribute any forcesthat may be generated between the stabilizing portion 104 and thefemoral head 206 and/or hip capsule 700 (FIG. 7A, 7B) over a larger areato help minimize damage to, for example, cartilage or bone surfaces ofthe femoral head 206.

Referring to FIGS. 3A and 3B, in an alternative implementation, amicrofracture device 300 includes a guide shaft 302, a stabilizingportion 304, and a flexible element 306. The guide shaft 302 has aproximal end 308 and a distal end 310, and can be cannulated such that alumen or internal passage (not shown) is disposed axially along itslength. The flexible element 306, for example, a flexible wire, can bepositioned within the internal passage such that flexible element 306extends both proximally and distally, respectively, beyond the proximaland distal ends 308, 310 of the guide shaft 302, and proximally beyondthe handle 314. Additionally, the distal end 310 of the guide shaft 302includes a curved tip region 312 that can guide the flexible element 306to a selected position and orientation, as described above with respectto the microfracture device 100 shown in FIGS. 1A and 1B. In someimplementations, the microfracture device 300 can include a handle 314coupled to, or formed integral with, the proximal end 308 of the guideshaft 302 to control the movement of the guide shaft 302 relative to thestabilizing portion 304 and the surgical site.

The stabilizing portion 304 includes a body 316 and a portion of thebody 316 that can receive the guide shaft 302. For example, an internalpassage (not shown) through the body 316 can receive at least a portionof the guide shaft 302 such that the guide shaft 302 can slide and/orrotate relative to the body 316. Additionally, the body 316 can includea flexible wide portion 318 having a conforming outer surface 320. Theconforming outer surface 320 can be substantially curved or contouredsuch that it generally conforms to a contacting bone surface, forexample, a portion of a femoral head (FIG. 2A). In some cases, theflexible wide portion 318 can be loosely fitted with respect to theguide shaft 302 such that the flexible wide portion 318 can tilt in alldirections relative to the guide shaft 302. Such tilting motion can helpenhance a conformability of the conforming outer surface 320 by firstgenerally tangentially orienting the outer surface 320 relative to thecontacting bone surface. Additionally, or alternatively, the body 316can define a cutout 322 such that additional constraints to the relativetilting motion of the flexible wide portion 318 are reduced.

The flexible wide portion 318 and the body 316 of the stabilizingportion 304 can be made from a single piece of material, or may beformed separately and attached to each other. The flexible wide portion318 can be made from any flexible or elastic material, such as anelastomer. The body 316 can be made from any biocompatible materialincluding elastomers and other polymers, metals, ceramics, orcombinations thereof. In some cases, the flexible wide portion 318 maybe coupled directly to the guide shaft 302 via, for example, an adhesiveor a press fit.

Referring now to FIG. 4, during a microfracture procedure, themicrofracture device 300 may be used as described above with respect toFIGS. 2A and 2B to create microfracture channels, such as channel 306,in the subchondral bone of, for example, the acetabular cup 204.Additionally, in use, the surgeon can position the flexible wide portion318 on the outer surface of the femoral head 206 such that the enhancedconformability between the conforming outer surface 320 and the outersurface of the femoral head 206 provides additional stability before andduring the channel drilling process.

Referring to FIG. 5, the guide shaft 102 of the microfracture device 100is shown in a retracted position for use during, for example, insertioninto and removal from the microfracture site. In the retracted position,the microfracture device 100 has a reduced cross-sectional area suchthat it can fit down, for example, a relatively thinner arthroscopiccannula and not snag on soft tissue. Additionally, or alternatively, theleading edge 128 and the trailing edge 130 reduces the likelihood of thewide portion 124 getting snagged on, for example, soft tissue.

Referring to FIG. 6, an angled distal tip 604 of a guide shaft 602includes one or more teeth 606 for driving into subchondral bone tissue,such as the acetabular cup 204 (FIG. 2A). In use, the surgeon can locatethe distal tip 604 at the microfracture site 202 (FIG. 2A) and embed atleast a portion or all of the teeth 606 into the surface of the bone.The teeth 606 can help minimize, for example, unseating of the distaltip 604 from the bone surface and/or skiving or dragging of the distaltip 604 across the bone surface as the flexible element is driven intothe subchondral bone tissue to form the microfracture channels.

Referring to FIG. 8, in an alternative implementation, a microfracturedevice 800 includes a microfracture pick 802 having a proximal end 804and a distal end 806. The pick 802 has a sharp bent tip 808 located onits distal end 806. The pick 802 includes a hinge or bracket 810 locatedbetween its proximal end 804 and its distal end 806. A support bracketor post 820 is rotationally or pivotally mounted to the hinge 810 suchthat it can be rotated to a position proximate the pick 802 or through anumber of angular positions relative to the pick 802. In someimplementations, the bracket 820 can be rotated through an arc ofapproximately 180 degrees relative to the pick 802.

In use, a surgeon delivers the pick 802 and rotatably connected bracket820 through, for example, a standard slotted arthroscopic cannula, to adesired location, such as an underside of an acetabular cup 204 as shownin FIG. 8, and places the tip 808 at the desired location for making achannel within the subchondral bone. In order to deliver the requiredforce for driving the tip 808 into the subchondral bone, the surgeon canposition a portion of the bracket 810, for example, a curved orsemi-cylindrical portion 822 of the bracket 810 onto a portion of a bonesurface, such as a portion of a femoral neck 206 a. Once in the desiredposition, the surgeon can apply a downward force (denoted by arrow F inFIG. 8) to the proximal end 804 of the pick 802. The applied downwardforce causes the distal end 806 of the pick 802 to rotate about thesupport bracket 820 such that the sharp tip 808 is driven into thesubchondral bone at the desired location. Utilizing the support bracket820 of the present implementation avoids contact with the overlyingcartilage or other soft tissues of the femoral head.

Referring to FIG. 9, the present disclosure further includes a method ofperforming a procedure such as microfracture stimulation 900. Theprocess 900 includes positioning a surgical device having a guide shaftwith a proximal end and a distal end and an angled tip at the distal endand a stabilizing portion disposed along an outer surface of the guideshaft proximate to a first bone surface such that an outer surface ofthe stabilizing portion is positioned against a portion of the firstbone surface 902. The positioning step 902 may include inserting atleast a portion of the surgical device into a standard arthroscopiccannula. The first bone surface can include a portion of a femoral head.The stabilizing portion can include an outer surface having one of asubstantially flat portion or a substantially curved portion and thepositioning step 902 includes positioning one of the substantially flator curved portions against the portion of the femoral head.

The process 900 also includes locating the angled tip of the guide shaftat a desired point of stimulation 904. Step 904 may include insertion ofat least a portion of the guide shaft into a standard arthroscopiccannula.

The process 900 includes driving an angled tip of a flexible elementthrough the guide shaft and into a second bone surface 906. The secondbone surface can include a portion of the acetabulum. The process 900includes removing the flexible element 908, thereby leaving a smallchannel in the underlying subchondral bone. Eventually, blood willtravel in the channel to form fibrous cartilage.

While this document contains many specific implementation details, theseshould not be construed as limitations on the scope of anyimplementations or of what may be claimed, but rather as descriptions offeatures specific to particular implementations. For example, the guideshafts 102, 302 may include additional bends and curves for improvedpositioning of the distal ends 110, 310, or to permit avoidance ofcertain structures such as the greater trochanter. In otherimplementations, the guide shafts 102, 302 may be a solid shaft designedto dig into the microfracture site 202 upon application of a downwardforce at the proximal end 108, 308. Certain features that are describedin this document in the context of separate implementations can also beimplemented in combination in a single implementation. Conversely,various features that are described in the context of a singleimplementation can also be implemented in multiple implementationsseparately or in any suitable subcombination. Moreover, althoughfeatures may be described above as acting in certain combinations andeven initially claimed as such, one or more features from a claimedcombination can in some cases be excised from the combination, and theclaimed combination may be directed to a subcombination or variation ofa subcombination. Thus, while particular implementations of the subjectmatter have been described, other implementations are within the scopeof the following claims.

What is claimed is:
 1. A microfracture device comprising: a guide shafthaving a proximal end and a distal end and defining an internal passagebetween the proximal and distal ends, the distal end having a curvedtip; a stabilizing portion disposed along an outer surface of the guideshaft, at least a portion of the stabilizing portion being wider thanthe guide shaft; and a flexible element movably positioned within theinternal passage of the guide shaft, the flexible element having adistal tip configured for driving into bone.
 2. The device of claim 1,further comprising a handle operatively coupled to the proximal end ofthe guide shaft.
 3. The device of claim 2, wherein the handle defines apassageway configured to receive a portion of the flexible elementtherethrough.
 4. The device of claim 2, wherein the handle isoperatively coupled to the proximal end of the guide shaft such that theguide shaft can be translated proximally and distally relative to thestabilizing portion and rotated relative to the stabilizing portion. 5.The device of claim 1, wherein the guide shaft comprises at least oneangled tip at the distal end of the guide shaft.
 6. The device of claim1, wherein the stabilizing portion comprises a body defining an internalpassage that receives a portion of the guide shaft therethrough.
 7. Thedevice of claim 6, wherein a portion of the body comprises asubstantially flat outer surface.
 8. The device of claim 6, wherein aportion of the body comprises a substantially curved outer surface. 9.The device of claim 6, wherein the body defines a longitudinallyextending slit that permits the guide shaft to be disposed in andremoved from the internal passage of the body.
 10. The device of claim1, wherein the stabilizing portion comprises a flexible body having atleast one substantially curved outer surface.
 11. The device of claim 1,wherein the flexible element comprises a proximal end that isoperatively configured to permit translation of the flexible elementproximally and distally through the internal passage of the guide shaft.12. The device of claim 10, wherein the proximal end of the flexibleelement is further operatively configured to permit rotation of theflexible element within the internal passage of the guide shaft.
 13. Thedevice of claim 1, wherein the flexible element comprises a flexiblewire.
 14. The device of claim 1, wherein the stabilizing portionincludes a recessed portion for receiving a portion of the curved tip ofthe distal end of the guide shaft.
 15. A surgical device comprising: aguide shaft having a proximal end and a distal end, the guide shaftdefining an internal passage between the proximal and distal ends andhaving an angled tip at the distal end of the guide shaft; a supportportion disposed about an outer surface of the guide shaft, at least aportion of the support portion being wider than the guide shaft; ahandle operatively coupled to the proximal end of the guide shaft, thehandle defining an internal passage; and a flexible element having aproximal and a distal end, the flexible element movably positionedwithin the internal passage of the guide shaft and the internal passageof the handle, the flexible element having an angled distal tip at thedistal end of the flexible element.
 16. The device of claim 14, whereinthe support portion comprises a body defining an internal passage thatreceives a portion of the guide shaft therethrough.
 17. The device ofclaim 15, wherein a portion of the body comprises a substantially flatouter surface.
 18. The device of claim 14, wherein the stabilizingportion comprises a flexible body having at least one substantiallycurved outer surface.
 19. A method of performing a microfractureprocedure comprising: positioning a surgical device having a guide shaftwith a proximal end and a distal end and an angled tip at the distal endand a stabilizing portion disposed along an outer surface of the guideshaft proximate to a first bone surface such that an outer surface ofthe stabilizing portion is positioned against a portion of the firstbone surface; locating the angled tip of the guide shaft at a desiredpoint of stimulation; driving an angled tip of a flexible elementthrough the guide shaft and into a second bone surface; and removing theflexible element.
 20. The method of claim 18, further comprisingengaging the angled tip of the guide shaft into the second bone surface.21. The method of claim 18, wherein the flexible element comprises aflexible wire, and wherein driving the angled tip of the flexible wirecomprises striking a proximal end of the flexible wire to translate theflexible wire relative to the guide shaft.
 22. The method of claim 18,wherein the flexible element comprises a flexible wire, and whereindriving the angled tip of the flexible wire comprising rotating aproximal end of the flexible wire to rotate the flexible wire relativeto the guide shaft.
 23. The method of claim 18, wherein the first bonesurface comprises a portion of a femoral head and the second bonesurface comprises a portion of the acetabulum.
 24. The method of claim22, wherein the stabilizing portion comprises an outer surface havingone of a substantially flat portion or a substantially curved portionand the positioning step comprises positioning one of the substantiallyflat or curved portions against the portion of the femoral head.
 25. Themethod of claim 18, wherein the positioning step includes the step ofinserting at least a portion of the surgical device into an arthroscopiccannula.